Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States
BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors assoc...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Christopher T. Aquina [verfasserIn] Zachary J. Brown [verfasserIn] Joal D. Beane [verfasserIn] Aslam Ejaz [verfasserIn] Jordan M. Cloyd [verfasserIn] Oliver S. Eng [verfasserIn] John R.T. Monson [verfasserIn] Samantha M. Ruff [verfasserIn] Gyulnara G. Kasumova [verfasserIn] Mohamed O. Adam [verfasserIn] Samilia Obeng-Gyasi [verfasserIn] Timothy M. Pawlik [verfasserIn] Alex C. Kim [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2022 |
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| Schlagwörter: |
cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) |
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| Übergeordnetes Werk: |
In: Frontiers in Oncology - Frontiers Media S.A., 2012, 12(2022) |
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| Übergeordnetes Werk: |
volume:12 ; year:2022 |
| Links: |
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| DOI / URN: |
10.3389/fonc.2022.970237 |
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| Katalog-ID: |
DOAJ022396616 |
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| 520 | |a BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. | ||
| 650 | 4 | |a appendiceal cancer | |
| 650 | 4 | |a colorectal cancer | |
| 650 | 4 | |a peritoneal metastases | |
| 650 | 4 | |a cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) | |
| 650 | 4 | |a healthcare disparities | |
| 650 | 4 | |a access to cancer care | |
| 653 | 0 | |a Neoplasms. Tumors. Oncology. Including cancer and carcinogens | |
| 700 | 0 | |a Christopher T. Aquina |e verfasserin |4 aut | |
| 700 | 0 | |a Zachary J. Brown |e verfasserin |4 aut | |
| 700 | 0 | |a Joal D. Beane |e verfasserin |4 aut | |
| 700 | 0 | |a Aslam Ejaz |e verfasserin |4 aut | |
| 700 | 0 | |a Jordan M. Cloyd |e verfasserin |4 aut | |
| 700 | 0 | |a Oliver S. Eng |e verfasserin |4 aut | |
| 700 | 0 | |a John R.T. Monson |e verfasserin |4 aut | |
| 700 | 0 | |a Samantha M. Ruff |e verfasserin |4 aut | |
| 700 | 0 | |a Gyulnara G. Kasumova |e verfasserin |4 aut | |
| 700 | 0 | |a Mohamed O. Adam |e verfasserin |4 aut | |
| 700 | 0 | |a Samilia Obeng-Gyasi |e verfasserin |4 aut | |
| 700 | 0 | |a Timothy M. Pawlik |e verfasserin |4 aut | |
| 700 | 0 | |a Alex C. Kim |e verfasserin |4 aut | |
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10.3389/fonc.2022.970237 doi (DE-627)DOAJ022396616 (DE-599)DOAJa330e162a979498d8c1b4f1c57e64470 DE-627 ger DE-627 rakwb eng RC254-282 Christopher T. Aquina verfasserin aut Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. appendiceal cancer colorectal cancer peritoneal metastases cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) healthcare disparities access to cancer care Neoplasms. Tumors. Oncology. Including cancer and carcinogens Christopher T. Aquina verfasserin aut Zachary J. Brown verfasserin aut Joal D. Beane verfasserin aut Aslam Ejaz verfasserin aut Jordan M. Cloyd verfasserin aut Oliver S. Eng verfasserin aut John R.T. Monson verfasserin aut Samantha M. Ruff verfasserin aut Gyulnara G. Kasumova verfasserin aut Mohamed O. Adam verfasserin aut Samilia Obeng-Gyasi verfasserin aut Timothy M. Pawlik verfasserin aut Alex C. Kim verfasserin aut In Frontiers in Oncology Frontiers Media S.A., 2012 12(2022) (DE-627)684965518 (DE-600)2649216-7 2234943X nnns volume:12 year:2022 https://doi.org/10.3389/fonc.2022.970237 kostenfrei https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 kostenfrei https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full kostenfrei https://doaj.org/toc/2234-943X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 |
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10.3389/fonc.2022.970237 doi (DE-627)DOAJ022396616 (DE-599)DOAJa330e162a979498d8c1b4f1c57e64470 DE-627 ger DE-627 rakwb eng RC254-282 Christopher T. Aquina verfasserin aut Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. appendiceal cancer colorectal cancer peritoneal metastases cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) healthcare disparities access to cancer care Neoplasms. Tumors. Oncology. Including cancer and carcinogens Christopher T. Aquina verfasserin aut Zachary J. Brown verfasserin aut Joal D. Beane verfasserin aut Aslam Ejaz verfasserin aut Jordan M. Cloyd verfasserin aut Oliver S. Eng verfasserin aut John R.T. Monson verfasserin aut Samantha M. Ruff verfasserin aut Gyulnara G. Kasumova verfasserin aut Mohamed O. Adam verfasserin aut Samilia Obeng-Gyasi verfasserin aut Timothy M. Pawlik verfasserin aut Alex C. Kim verfasserin aut In Frontiers in Oncology Frontiers Media S.A., 2012 12(2022) (DE-627)684965518 (DE-600)2649216-7 2234943X nnns volume:12 year:2022 https://doi.org/10.3389/fonc.2022.970237 kostenfrei https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 kostenfrei https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full kostenfrei https://doaj.org/toc/2234-943X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 |
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10.3389/fonc.2022.970237 doi (DE-627)DOAJ022396616 (DE-599)DOAJa330e162a979498d8c1b4f1c57e64470 DE-627 ger DE-627 rakwb eng RC254-282 Christopher T. Aquina verfasserin aut Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. appendiceal cancer colorectal cancer peritoneal metastases cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) healthcare disparities access to cancer care Neoplasms. Tumors. Oncology. Including cancer and carcinogens Christopher T. Aquina verfasserin aut Zachary J. Brown verfasserin aut Joal D. Beane verfasserin aut Aslam Ejaz verfasserin aut Jordan M. Cloyd verfasserin aut Oliver S. Eng verfasserin aut John R.T. Monson verfasserin aut Samantha M. Ruff verfasserin aut Gyulnara G. Kasumova verfasserin aut Mohamed O. Adam verfasserin aut Samilia Obeng-Gyasi verfasserin aut Timothy M. Pawlik verfasserin aut Alex C. Kim verfasserin aut In Frontiers in Oncology Frontiers Media S.A., 2012 12(2022) (DE-627)684965518 (DE-600)2649216-7 2234943X nnns volume:12 year:2022 https://doi.org/10.3389/fonc.2022.970237 kostenfrei https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 kostenfrei https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full kostenfrei https://doaj.org/toc/2234-943X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 |
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10.3389/fonc.2022.970237 doi (DE-627)DOAJ022396616 (DE-599)DOAJa330e162a979498d8c1b4f1c57e64470 DE-627 ger DE-627 rakwb eng RC254-282 Christopher T. Aquina verfasserin aut Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. appendiceal cancer colorectal cancer peritoneal metastases cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) healthcare disparities access to cancer care Neoplasms. Tumors. Oncology. Including cancer and carcinogens Christopher T. Aquina verfasserin aut Zachary J. Brown verfasserin aut Joal D. Beane verfasserin aut Aslam Ejaz verfasserin aut Jordan M. Cloyd verfasserin aut Oliver S. Eng verfasserin aut John R.T. Monson verfasserin aut Samantha M. Ruff verfasserin aut Gyulnara G. Kasumova verfasserin aut Mohamed O. Adam verfasserin aut Samilia Obeng-Gyasi verfasserin aut Timothy M. Pawlik verfasserin aut Alex C. Kim verfasserin aut In Frontiers in Oncology Frontiers Media S.A., 2012 12(2022) (DE-627)684965518 (DE-600)2649216-7 2234943X nnns volume:12 year:2022 https://doi.org/10.3389/fonc.2022.970237 kostenfrei https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 kostenfrei https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full kostenfrei https://doaj.org/toc/2234-943X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 |
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10.3389/fonc.2022.970237 doi (DE-627)DOAJ022396616 (DE-599)DOAJa330e162a979498d8c1b4f1c57e64470 DE-627 ger DE-627 rakwb eng RC254-282 Christopher T. Aquina verfasserin aut Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. appendiceal cancer colorectal cancer peritoneal metastases cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) healthcare disparities access to cancer care Neoplasms. Tumors. Oncology. Including cancer and carcinogens Christopher T. Aquina verfasserin aut Zachary J. Brown verfasserin aut Joal D. Beane verfasserin aut Aslam Ejaz verfasserin aut Jordan M. Cloyd verfasserin aut Oliver S. Eng verfasserin aut John R.T. Monson verfasserin aut Samantha M. Ruff verfasserin aut Gyulnara G. Kasumova verfasserin aut Mohamed O. Adam verfasserin aut Samilia Obeng-Gyasi verfasserin aut Timothy M. Pawlik verfasserin aut Alex C. Kim verfasserin aut In Frontiers in Oncology Frontiers Media S.A., 2012 12(2022) (DE-627)684965518 (DE-600)2649216-7 2234943X nnns volume:12 year:2022 https://doi.org/10.3389/fonc.2022.970237 kostenfrei https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 kostenfrei https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full kostenfrei https://doaj.org/toc/2234-943X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 |
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Christopher T. Aquina @@aut@@ Zachary J. Brown @@aut@@ Joal D. Beane @@aut@@ Aslam Ejaz @@aut@@ Jordan M. Cloyd @@aut@@ Oliver S. Eng @@aut@@ John R.T. Monson @@aut@@ Samantha M. Ruff @@aut@@ Gyulnara G. Kasumova @@aut@@ Mohamed O. Adam @@aut@@ Samilia Obeng-Gyasi @@aut@@ Timothy M. Pawlik @@aut@@ Alex C. Kim @@aut@@ |
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This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients &gt;65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. 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Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States |
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Christopher T. Aquina |
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Frontiers in Oncology |
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Christopher T. Aquina Zachary J. Brown Joal D. Beane Aslam Ejaz Jordan M. Cloyd Oliver S. Eng John R.T. Monson Samantha M. Ruff Gyulnara G. Kasumova Mohamed O. Adam Samilia Obeng-Gyasi Timothy M. Pawlik Alex C. Kim |
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10.3389/fonc.2022.970237 |
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disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: a medicare insurance-based study in the united states |
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RC254-282 |
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Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States |
| abstract |
BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. |
| abstractGer |
BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. |
| abstract_unstemmed |
BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations. |
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Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States |
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https://doi.org/10.3389/fonc.2022.970237 https://doaj.org/article/a330e162a979498d8c1b4f1c57e64470 https://www.frontiersin.org/articles/10.3389/fonc.2022.970237/full https://doaj.org/toc/2234-943X |
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Christopher T. Aquina Zachary J. Brown Joal D. Beane Aslam Ejaz Jordan M. Cloyd Oliver S. Eng John R.T. Monson Samantha M. Ruff Gyulnara G. Kasumova Mohamed O. Adam Samilia Obeng-Gyasi Timothy M. Pawlik Alex C. Kim |
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Christopher T. Aquina Zachary J. Brown Joal D. Beane Aslam Ejaz Jordan M. Cloyd Oliver S. Eng John R.T. Monson Samantha M. Ruff Gyulnara G. Kasumova Mohamed O. Adam Samilia Obeng-Gyasi Timothy M. Pawlik Alex C. Kim |
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